More than 20 years ago, Andrea Yates, a Texas mother of five, drowned her children in the bathtub. She said she was saving them from going to hell.
She was suffering from postpartum psychosis.
"This is not an evil act. This is an act that occurs in the context of severe illness," said Dr. Margaret Howard, the director of the Division of Behavioral Health at Women and Infants Hospital.
"There's a perceptual disconnect from what's actually happening and what they believe to be happening," said Dr. Abbie Goldberg, a psychology professor at Clark University in Worcester, and an expert in postpartum depression.
Signs of this very rare type of psychosis may be very subtle.
"They may chalk it up to, 'She just had a baby. Well, she hasn't been sleeping.' But I think loved ones need to pay attention to, you know, kind of that sixth sense of there's just something that isn't right," said Howard.
"If they seem paranoid, that can be a very notable sign, sort of a belief that people are against me, or leave me alone, you don't believe I'm a good parent, stop harassing me, people are following me or they're having delusions or you're hearing things that aren't there," said Goldberg.
"It is horrific for the woman who then gets treatment and then become reengaged with reality," said Howard.
"They will experience a lot of, sometimes shock, grief, shame, fear around those thoughts and in this situation, and situations like it, when a person survives their own, say suicide attempt, there is a reckoning with what one has done," added Goldberg.
Both say treatments are highly effective in treating postpartum depression.
Those at highest risk include those with a history of postpartum depression, depression/anxiety, family history, significant stressors and lack of social supports.
The key is recognizing it and seeking out treatment.